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腹主动脉瘤开放手术患者的术前心脏评估及围手术期心脏治疗:对心血管结局的影响

Preoperative cardiac evaluation and perioperative cardiac therapy in patients undergoing open surgery for abdominal aortic aneurysms: effects on cardiovascular outcome.

作者信息

Faggiano Pompilio, Bonardelli Stefano, De Feo Stefania, Valota Mariangela, Frattini Silvia, Cervi Edoardo, Guadrini Cristina, Giulini Stefano M, Dei Cas Livio

机构信息

Division of Cardiology, Spedali Civili, University of Brescia, Brescia, Italy.

出版信息

Ann Vasc Surg. 2012 Feb;26(2):156-65. doi: 10.1016/j.avsg.2011.06.019.

Abstract

BACKGROUND

Cardiovascular complications, such as death, myocardial infarction, or heart failure, are the leading causes of morbidity and mortality in adult patients undergoing major noncardiac surgery.

OBJECTIVE

To evaluate the effects of an accurate preoperative cardiac evaluation, together with optimized perioperative drug therapy, in reducing cardiovascular events in patients undergoing open aortic surgery for abdominal aneurysm.

METHODS

Between January 2000 and December 2008, we considered all consecutive patients undergoing elective abdominal aortic open surgery at the Vascular Surgery Unit of the University of Study-Spedali Civili (Italy). Since January 2003, we have used an intensive cardiac preoperative evaluation: patients with at least one cardiac risk factor received a preoperative cardiac evaluation; all non-invasive and invasive tests were performed preoperatively when indicated by the consultant cardiologist, that also optimized the pharmacological perioperative therapy. The outcome of the 418 patients undergoing surgery between 2003 and 2008 was compared with those of the 204 patients in the previous triennium 2000 to 2002, when only patients with positive history for cardiac disease received a standard preoperative cardiological clinical or instrumental evaluation.

RESULTS

Patients enrolled in the 2003 to 2008 interval were slightly older and with a higher prevalence of comorbidities compared with those observed in the previous triennium; furthermore, the number of noninvasive tests performed before surgery increased significantly. Nevertheless, the number of major cardiac perioperative complications decreased over time: particularly, in-hospital mortality rate was 0.9% in the latter period, compared with 3.4% in the years 2000 to 2002. Also, the long-term mortality was significantly reduced in patients operated on between 2003 and 2008 compared with those operated on in the previous triennium.

CONCLUSION

These data suggest a significant benefit of an intensive cardiac preoperative evaluation in reducing the incidence of perioperative and postoperative cardiac morbidity and mortality.

摘要

背景

心血管并发症,如死亡、心肌梗死或心力衰竭,是接受非心脏大手术的成年患者发病和死亡的主要原因。

目的

评估准确的术前心脏评估以及优化的围手术期药物治疗对降低腹主动脉瘤开放手术患者心血管事件的影响。

方法

2000年1月至2008年12月期间,我们纳入了意大利锡耶纳大学圣乔瓦尼医院血管外科接受择期腹主动脉开放手术的所有连续患者。自2003年1月起,我们采用了强化的术前心脏评估:至少有一项心脏危险因素的患者接受术前心脏评估;所有非侵入性和侵入性检查均在术前由心脏科顾问医生根据指征进行,其还优化了围手术期药物治疗。将2003年至2008年期间接受手术的418例患者的结果与2000年至2002年前三年期间的204例患者进行比较,当时只有有心脏病阳性病史的患者接受标准的术前心脏临床或器械评估。

结果

与前三年观察到的患者相比,2003年至2008年期间纳入的患者年龄稍大,合并症患病率更高;此外,术前进行的非侵入性检查数量显著增加。然而,围手术期主要心脏并发症的数量随时间减少:特别是,后期的住院死亡率为0.9%,而2000年至2002年期间为3.4%。同样,与前三年接受手术的患者相比,2003年至2008年接受手术的患者长期死亡率也显著降低。

结论

这些数据表明强化的术前心脏评估在降低围手术期和术后心脏发病率和死亡率方面具有显著益处。

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